Next-generation immunotherapy in relapsed/refractory multiple myeloma: Strategies to achieve sustained MRD negativity

Abstract

This study critically examines the evolving landscape of Multiple Myeloma (MM) treatment, spotlighting the shift towards immunotherapeutic strategies in combating this complex hematological malignancy. Despite the clinical challenges posed by MM, including its high relapse and progression rates, recent therapeutic innovations have ushered in a new era of treatment possibilities. The advent of proteasome inhibitors and immunomodulatory drugs, and more recently BCMA‑targeted immunotherapies such as CAR‑T cells and bispecific antibodies, has broadened therapeutic options in multiple myeloma. These modalities show significant potential to achieve sustained minimal residual disease (MRD) negativity and improve patient outcomes. Addressing the limitations of conventional therapies, this review highlights the critical need for novel treatment modalities that can provide durable responses and overcome the disease's inherent resistance to treatment. The analysis further explores the impact of immunotherapeutic approaches, particularly for patients with relapsed or refractory MM, while acknowledging the ongoing challenges related to treatment resistance, side effects, and therapy accessibility. Additionally, it advocates for the integration of immunotherapy into earlier treatment protocols and emphasizes the importance of global accessibility to these advanced treatments. Through this exploration, the review aims to contribute to the hematological community's ongoing dialogue and research efforts, striving to refine MM treatment strategies, enhance patient outcomes, and advance towards the ultimate goal of finding a cure for MM.

Keywords: BCMA; Bi-specific antibody; CAR-T; MRD; Multiple myeloma.